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MedVet Medical and Cancer Center for Pets January 14, 2014 ACVR Residency Training Program Application Form: Institution Name MedVet Medical and Cancer Centers for Pets (MedVet Columbus) This document is to act as a guide for institutions desiring ACVR accreditation of their residency training program. It should be used in concert with the requirements set out in the ACVR Essentials of Residency Training document and it follows the headings of that document. It is intended to streamline the application process and help define what information the RSEC needs to evaluate the program. All terms used in this application have same definitions as defined in the Essentials. II. Objectives: Provide clinical training in all modalities of veterinary diagnostic imaging to prepare graduates for successful completion of the American College of Veterinary Radiology board certification examination. III. Training period: What is the total length of the training program in months? 36 months If this is a 4 year program, during what year will the resident be eligible to take the ACVR Preliminary Exam? If the resident is not eligible to take the exam during the beginning of the 3rd year (September), please state the reason. What is the total duration of supervised clinical training in the program? 32 months What are the responsibilities of the resident in the remaining non-clinical portion of the program? 1. Self-study and board exam preparation 2. Attend short courses at other institutions 3. Research 4. Vacation IV. Direction and Supervision: Program Director: Who is the Director of Residency training? Adam T Watson, DVM, DACVR What percentage of this individual’s time is committed to clinical service and teaching of residents? 90% Last Revised: November 25, 2008 MedVet Medical and Cancer Center for Pets January 14, 2014 Faculty: Please list the faculty member of the program accepting PRIMARY responsibility for training in each of the following core areas: Roentgen diagnosis: Faculty: Jonathan T. Shiroma, DVM, MS, DACVR Percentage clinical service: 85% Diagnostic ultrasound: Faculty: Jonathan T. Shiroma, DVM, MS, DACVR Percentage clinical service: 85% Computed Tomography Faculty: Adam T. Watson, DVM, DACVR Percentage clinical service: 90% Magnetic Resonance Imaging: Faculty: Adam T. Watson, DVM, DACVR Percentage clinical service: 90% Nuclear Medicine: Faculty: Adam T. Watson, DVM, DACVR Percentage clinical service: 90% List the names and percentage clinical commitment of additional imaging faculty in the program, and their area(s) of instructional responsibility. For each imaging faculty in the program please provide a one page CV documenting their expertise in the area(s) of assigned responsibility. For each of the specialty colleges listed below please list at least two Diplomates of these colleges who can be expected to regularly interact with radiology residents: ACVIM Roger Hostutler, DVM, MS, DACVIM Stephen Martinez, DVM, DACVIM ACVS Robert Dudley, DVM, MS, DACVS Shawn Kennedy, DVM, DACVR ACVP Seth Chapman, DVM, MS, DACVP – Clinical pathology Mark Chalkley, BSc, BVSc (Hons), MANZCVSc (Pathobiology), DACVP – Anatomic pathology V. Affiliation agreement: Last Revised: November 25, 2008 MedVet Medical and Cancer Center for Pets January 14, 2014 If all of the training will not be accomplished on-site, please attach a copy of the affiliations agreement(s). Include the scope of the training and amount of time the resident will be away from the home institution. See attached affiliation agreement with Michigan State University VI. Facilities: Briefly describe how the program meets the facility requirements. MedVet Medical and Cancer Centers for Pets in Columbus, OH is a premier multispecialty and emergency practice that was awarded the AAHA-Accredited referral practice of the year in 2014. The radiology department is composed of two board-certified ACVR diplomates and a diagnostic imaging resident. This department plays an essential diagnostic role for the specialty departments, satellite MedVet hospitals in the Midwest and gulf coast regions as well as the referral veterinary community. Through advanced video teleconferencing capabilities, the radiologists and residents at both the Columbus and Cincinnati locations collaborate in didactic residency training including known case conference, journal club, advanced imaging rounds and multispecialty tumor rounds. Through an affiliation with Michigan State University, the resident will be trained in large animal imaging and nuclear medicine via direct visits at set points in the program as well as intermittent collaborative video teleconferencing rounds with the MSU radiology department. IDEXX pathology is located within this campus fostering direct interaction with two clinical pathologists and one anatomic pathologist to correlate imaging findings with disease. Equipment is as follows: MedVet Medical and Cancer Centers for Pets: Columbus Radiology (small animal) Two Sedecal high frequency x-ray machines with Canon DR plates Fluoroscopy GE 9800 digital C-arm fluoroscope Ultrasonography Two GE Logiq 7 Computed Tomography GE LightSpeed 16 slice MRI 1.5 Tesla GE Signa Echospeed Plus MRI scanner Michigan State University Radiology (large animal) • Large animal room1: 80kw three-phase generator. Maxiray 100-18 X-ray tube with • Advantx digital fluoroscopy system and Agfa CR system • Large Animal room 2: Mobile Maxiray 75-18N Nuclear Medicine • Gamma Camera: Scintron VI with embedded motion correction from Medical Imaging Electronic Last Revised: November 25, 2008 MedVet Medical and Cancer Center for Pets January 14, 2014 VII. Clinical resources: Indicate the approximate number of patients seen annually by the home institution? MedVet Columbus: 45,000 small animal patients What is the annual imaging caseload? 18,250 Indicate the approximate breakdown of the patient population according to species. Small animals (canine, feline) 99% (MedVet) Large animals (equine and food animals) 13% (Michigan State University) Exotic animals 1% (MedVet & Columbus Zoo) What is the approximate annual imaging caseload of the program in: Small Animal Radiology: 14,500 (MedVet) Large Animal Radiology: 900 (Michigan State University) Abdominal Ultrasound: 3300 (MedVet) Computed Tomography: 350 (MedVet) Nuclear Medicine: 100 (Michigan State University) Magnetic Resonance Imaging: 600 (MedVet) Other (specify): Last Revised: November 25, 2008 MedVet Medical and Cancer Center for Pets January 14, 2014 VIII. Training content: What percentage of imaging reports are typically available within 48 hours after the examination is conducted in typewritten or electronic form? 95% If your answer is less than 75% please explain how reports are generated and how long it takes for the report to be available for review in typewritten form. Of the preliminary reports generated from the imaging caseload what percentage are initially produced by the resident? The percentage of reports will increase over the course of the residency but we anticipate that over the 3 years, the resident will generate up to 25% of the total imaging caseload reports. What percentage of resident reports are reviewed by the imaging faculty prior to finalization of the report? We review 100% of imaging reports generated during the weekdays and the majority of reports from the weekends. When preliminary resident reports are reviewed and edited by the imaging faculty responsible for training, what percentage of the time are two or more faculty present? Both faculty are generally not concurrently available to review the radiographic, CT and MRI resident reports. Reports on challenging cases are oftentimes reviewed by both faculty. Ultrasound studies are only be reviewed by one of the faculty. Please complete the table below Approximate number of cases in the 30 months clinical experience Small Animal Radiology: 10,000 Large Animal Radiology: 75 (MSU) Abdominal Ultrasound: 3,000 Computed Tomography: 500 Nuclear Medicine: 10 (MSU) Magnetic Resonance Imaging: 350 Elective (any of above) Required elective (specify): Last Revised: November 25, 2008 MedVet Medical and Cancer Center for Pets Total January 14, 2014 13,885 Please indicate the course number and unit assignment residents are required to take to meet the educational objectives for formal instruction as outlined in the Essentials in the following: Topic Course number Units Radiobiology: The Physics of: Diagnostic Radiology: Nuclear Medicine: Ultrasonography: CT: MRI: If your program does not offer formal courses in any or all of these topics please indicate how these educational objectives for each are met. Use attached sheets if necessary. At this time, no formal courses will be offered to cover the above objectives. Instead, these objectives will be covered by scheduled topics rounds and organized study modules. A written practice exam will follow each board objective studying period to assess the resident’s progress during the 1st and 2nd years. The ACVR board objective notes will serve as a basic framework for studying. Textbooks, journal articles and faculty board studying notes will also be provided for each of the objectives. An outline for studying each board objective is listed below. Summer/Fall (1st year) – Pathophysiology –The resident will be instructed to reference The Textbook of Veterinary Internal Medicine and Small Animal Cardiovascular Medicine. Winter 2013 (1st year) – Anatomy – Emphasis will be placed on clinical radiographic and cross-sectional anatomy. Study modules using PowerPoint format will be used requiring labeling of images. Spring 2013 – (1st year) - Radiobiology – Faculty-driven study modules will be constructed reviewing chapters in Radiobiology for the Radiologist (Hall) and following the ACVR board objectives. Summer 2013 (2nd year) – Physics of Diagnostic Radiology – The resident will be Last Revised: November 25, 2008 MedVet Medical and Cancer Center for Pets January 14, 2014 required to read The Essential Physics of Medical Imaging, Vol 3 (Bushberg) and reference Christensen’s Physics of Diagnostic Radiology, Vol 4, when applicable. Organized self-study modules will be constructed. Fall 2013 (2nd year) – Special Procedures – The board objectives will serve as a basic framework for studying. Board studying notes will be supplied. Archived echocardiography movie files and notes will be provided for this aspect of the training. Winter 2013 (2nd year) – Alternative Imaging – MRI, CT, ultrasound and nuclear medicine will be covered individually beginning with the physics of each modality and then reviewing the applicable literature/journal articles. Board studying notes will be supplied for each modality. The resident will be expected to read The Handbook of Nuclear Medicine (Daniel) and Diagnostic Ultrasound: Principals and Instruments, 7th edition (Kremkau). Physics of MRI and CT will be covered in The Essential Physics of Medical Imaging (Bushberg). Additionally, the resident will attend the Nuclear Medicine Short Course at the University of Tennessee and MRI short course at North Carolina State University in 2013 or 2014. Organized self-study modules will be constructed to further training in the physics of these modalities. After completing each board objective, a written exam will be given to the resident and the results will be discussed. IX. Research Environment: Over the last 5 years, what is the average number of peer reviewed publications, on which the IMAGING faculty listed under Direction and Supervision in IV above are included as authors? Adam T. Watson, DVM, DACVR: 2 Jonathan T. Shiroma, DVM, MS, DACVR: 1 What is the number of publications/submissions expected of a resident completing the program? A minimum of 1 original study will be required. Emphasis will be placed on a prospective study. Additional case reports, review articles and retrospective studies will be encouraged time permitting. Last Revised: November 25, 2008 MedVet Medical and Cancer Center for Pets January 14, 2014 If this is an established program, what percentage of residents have made formal research presentations at the annual ACVR or equivalent national meeting? 1st resident scheduled to present at 2015 national ACVR meeting. Is an advanced degree a requirement of the training program? No X. Educational Environment: How many lectures or scientific presentations are expected of each resident during the course of their training? Two hospital grand rounds presentations are required per year. Additional imaging topics rounds and continuing education lectures to the local veterinary community will be required. An abstract presentation at the ACVR conference will be required either at the beginning or end of the resident’s 3rd year in training. XI. Evaluation: During the program how often is resident performance evaluated in writing? The resident’s performance will be formally reviewed by the MedVet organization on a bi-annual basis and radiology department on a quarterly basis to track progress and provide feedback. XII. Teaching File: What is the nature and scope of the teaching file available to residents? A large imaging teaching file has been organized including radiography, special procedures, CT, MRI and ultrasound cases that include cases from all associated MedVet practices where reports are generated and is updated by the Columbus and Cincinnati radiology groups. The file is in Microsoft excel format and is searchable using different coded parameters. All digital images are saved and searchable on a PACS system. MSU collaboration will also allow for exposure to a large animal teaching file. The resident will be required to attend weekly didactic tumor rounds and twice monthly hospital grand rounds. Residents are encouraged to attend cytology and internal medicine rounds on a weekly basis time permitting. Hospital grand rounds are scheduled twice monthly. How is it maintained/updated? All digital images are archived on the PACS system for retrieval. Case information is updated using the Excel spreadsheet described above. XIII. Conferences: Last Revised: November 25, 2008 MedVet Medical and Cancer Center for Pets January 14, 2014 On average how many Known Case Conferences are conducted annually? Twenty. XIV. Literature resources: What is the geographic relationship between the nearest medical library and the training program? The nearest medical library is located approximately 15 minutes from the hospital at The Ohio State University College of Veterinary Medicine. We maintain a large number of both small animal and large imaging textbooks and digital database of journal articles and have electronic access to many applicable journals. XV. Appendix: (a) Provide the pass rate for first time, second time, etc for both the preliminary and certifying exams for your residents for the past 5 years. For example, for all residents finishing your program 5 years ago (Year 5), check the appropriate box. Complete the table for residents finishing 4 years ago (Year 4), 3 years ago (Year 3), etc. Year 5 Year 4 Year 3 Year 2 Year 1 Passed 1 preliminary exam 1st time Passed prelim exam 2nd time Passed prelim after 2nd time Passed certifying exam 1st time Passed certifying exam 2nd time Passed certifying exam after 2nd time Unsuccessful in all attempts (b) Provide a clinical schedule for your resident(s). This schedule should provide a weekly or monthly outline of the resident’s clinical responsibilities. This may be in the form of a master schedule or duty roster for your entire radiology section if desired. Last Revised: November 25, 2008 MedVet Medical and Cancer Center for Pets January 14, 2014 The resident will be required to attend daily morning radiology rounds supervised by one or both faculty throughout the entire residency program. The following is a summary of the resident’s monthly rotating schedule from their 1st through 3rd years. Weeks 1 and 2: Primary responsibility is diagnostic radiology. The resident will dictate (oral and/or type) radiographic reports for in-house specialty and emergency studies. All reports will be reviewed by 1 or both faculty and reports will be finalized within 24 hours. The resident will also be responsible for attending or performing any special procedures (myelography, contrast radiography, fluoroscopy). Week 3: Primary responsibility is ultrasound. The resident will be the primary ultrasonographer for in-house ultrasound cases (abdomen, thorax, small parts). Faculty will initially be directly supervising the resident during each scan and reviewing all reports. As the resident gains skill level, the faculty will be responsible for reviewing images for quality control and continue to review all reports. Overflow ultrasound cases will be performed directly by the faculty not assigned to the resident. Week 4: Primary responsibility is CT and MRI. The resident will be directly involved in case planning and quality control for each modality including sequence selection for MRI. The resident will be under direct supervision initially. The resident will be directly communicating with the MRI and CT technician on-site during the scans for protocol selection and case management. The resident will begin generating CT and MRI reports. All reports will be reviewed by at least 1 faculty. The resident will be sent to Michigan State University for a total of 5-6 weeks of supervised clinical nuclear medicine and large animal radiology training during their second and third years. Additional training in this modality will be gained through self-studying using the Michigan State University’s teaching file, through joint KCC with the MSU radiology department via video teleconferencing and from attending the Nuclear Medicine Short Course as outlined previously. The resident may rotate in the cardiology department at MedVet for up to 2 weeks to gain an understanding of echocardiography and angiography. Off-clinics time (16 weeks) will be allotted for board studying and research. Additional time-off will be built-in to the schedule for vacation, attendance to short courses and rotation to MSU as described in section III. Last Revised: November 25, 2008